Stem Cells in Rapidly Evolving Active Multiple Sclerosis (STREAMS)

This is a randomised, double-blind crossover study to study the effect of intravenous treatment with autologous (derived from the individuals themselves) mesenchymal stem cells (MSCs) in patients with multiple sclerosis (MS).

Study Overview

• Status: Completed
• Conditions: Multiple Sclerosis
• Intervention / Treatment: Drug: Placebo; Drug: Mesenchymal stem cells

Detailed Description

Current treatments for MS target the immune system and are not curative. There is much interest in MSCs as they have the potential to not only affect the immune system but may also promote repair. This study will use MSCs that are harvested from the bone marrow and grown for up to 52 days before being given back to the person from whom they were harvested. This avoids any chemotherapy so is therefore safer than other types of stem cells. In this crossover study, everyone will receive their own stem cells back but in half of the patients it will be delayed by 24 weeks.

The primary outcomes are to check that the procedure is safe and to measure any changes on the MRI at 24 weeks. Other more exploratory measures will try to assess effects on repair in the central nervous system (CNS).

• Study Type: Interventional
• Enrollment (Actual): 21
• Phase: Phase 2; Phase 1

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom, W12 0NN
    • Imperial College Healthcare NHS Trust

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 50 years (Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

Patients with clinically and radiologically active multiple sclerosis as defined by:

1. Diagnosis of MS:

   • Relapsing remitting MS (RRMS): ≥ 1 moderate-severe relapse and ≥1 GEL in past 18 months or ≥ 1 moderate-severe relapse and ≥1 new T2 lesion in past 18 months.
   • Secondary progressive MS (SPMS) with an increase of ≥ 1 EDSS point (if baseline EDSS ≤ 5) or 0.5 EDSS point (if baseline EDSS ≥ 5.5), in the previous 18 months and ≥ 1 GEL in past 18 months or ≥ 1 moderate-severe relapse and ≥1 new T2 lesion in past 18 months.
   • Primary progressive MS (PPMS) patients with positive oligoclonal bands (OCBs) in the cerebrospinal fluid (CSF) and an increase of ≥ 1 EDSS point (if baseline EDSS is ≤ 5.0) or 0.5 EDSS point (if baseline EDSS is ≥ 5.5), or quantifiable, objective evidence of equivalent progression in the previous 18 months and ≥ 1 GEL in past 18 months or ≥ 1 new T2 lesion in past 18 months.
2. Age 18 to 50 years.
3. Disease duration 2 to 10 years from diagnosis (inclusive).
4. Expanded Disability Status Scale (EDSS) 2.0 to 6.5 at screening evaluation.
5. ≥ 1 GEL on MRI within 6 months prior to harvesting.
6. Adequate culture of a subject's MSCs and their release for clinical use.

Exclusion Criteria:

1. RRMS without at least one severe relapse in the previous 18 months or without at least one GEL or one new T2 in the previous 18 months.
2. SPMS without relapses and without new lesions (GEL or T2 positive) at MRI in the last 18 months.
3. PPMS without positive CSF OCBs or without a GEL or new T2 lesion in the previous 18 months.
4. No gadolinium enhancing lesion(s) in the 3 months prior to bone marrow harvesting.
5. A previously ineligible patient who failed to meet the MRI requirements of the inclusion criteria will not be reviewed again even if further imaging, revealing ≥ 1 GEL, becomes available.
6. Failure of bone marrow (BM) sample to generate MSCs suitable for clinical use within a specified time frame (4 weeks).
7. Treatment with any immunosuppressive therapy, including natalizumab and fingolimod, within the last 3 months.
8. Treatment with interferon-beta or glatiramer acetate within the last 1 month.
9. Treatment with alemtuzumab (campath-1H) within the last 2 years.
10. Prior treatment with total lymphoid irradiation and autologous or allogeneic hematopoietic stem cell transplantation.
11. Participation in clinical trials of any experimental drugs in the 6 months before study entry.
12. Corticosteroid treatment in the last 30 days.
13. Presence of any active or chronic infection.
14. Previous history of a malignancy other than basal cell carcinoma of the skin and carcinoma in situ that has been in remission for more than one year.
15. Severely limited life expectancy by any other co-morbid illness.
16. Abnormal blood counts, a history of myelodysplasia or other cytopenia.
17. Known pregnancy, positive urine pregnancy test at screening or risk or pregnancy (this includes patients who are unwilling to practice active contraception during the duration of the study).
18. Contraindication to MRI including but not limited to intracranial aneurysm clips (except Sugita), history of intra-orbital metal fragments that have not been removed by an MD (as confirmed by orbital X-Ray), pacemaker and non-MRI compatible devices (e.g. heart valves, inner ear implants), history of claustrophobia or the inability of the subject to lie still on their back for a period of 1.5 hours in the MRI scanner.
19. An estimated glomerular filtration rate (eGFR)< 60 mL/min/1.73m2 or history or presence of renal impairment (e.g. serum creatinine clearance less than 30ml/min).
20. Inability to give written informed consent/comply with study procedures.
21. Any significant organ dysfunction or co-morbidity that the Investigators consider would put the subject at unacceptable risk by participating in the study or that would interfere with the functional assessments.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: Quadruple

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: mesenchymal stem cells; 1-2 x106 MSCs/kg administered at Week 0	Drug: Mesenchymal stem cells; 1.0-2.0 million cells/kg body weight; Other Names: Mesenchymal stromal cells
Sham Comparator: Placebo; Suspension media administered at Week 0	Drug: Placebo; Placebo; Other Names: Sham

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Frequency, Timing and Severity of Adverse events in MSC and placebo groups as Assessed by CTCAE v4.0	The number,time-frame and severity of adverse events in the stem cell treatment group will be compared to the placebo group.	Up to 1 year from baseline
Total number of GELs at weeks 4, 12 and 24 after MSC therapy	To evaluate the efficacy of autologous mesenchymal stem cells in MS patients, quantified by the reduction in the number of new contrast-enhancing lesions on MRI scans over 24 weeks and the total number of GEL counted over months 1, 3 and 6 will be compared between treatment groups.	Up to 1 year from baseline

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
contrast enhancing lesions identified over months 1, 3 and 6 will be compared between treatment groups.	Number of contrast enhancing lesions identified over months 1, 3 and 6 will be compared between treatment groups.	Months 1, 3 and 6
Comparison of contrast enhancing lesions between treatment periods	The number of contrast enhancing lesions counted over months 7, 9 and 12 (cross-over re-treatment) compared between treatment periods (placebo vs. active treatment) for each patient.	Months 1-12
Combined unique MRI activity	The number of new or enlarging T2, or enhancing or re-enhancing lesions.	Months 1-12
Relapses	number of relapses in MSC treatment group vs. placebo group in the first 6 months and after cross-over re-treatment in the two groups	20 months
Progression of disability	time to sustained progression of disability and proportion of progression-free patients.	36 months
Disease free patients	The proportion of disease-free patients (i.e. patients without relapses) and progression of MRI activity in the two groups.	36 months
MSFC score	the changes in the Multiple Sclerosis Functional Composite (MSFC) score in MSC treatment group compared to the placebo group.	36 months
peripheral immune responses	changes in immune cell frequencies and serum cytokines after MSCs	48 weeks
Type 4 hypersensitivity reaction	The effect of mesenchymal stem cells on delayed type hypersensitivity (Type 4 hypersensitivity reaction) as measured by the Mantoux test	48 weeks

Collaborators and Investigators

• Sponsor: Imperial College London
• Investigators: Principal Investigator: Paolo A Muraro, MD PhD, Imperial College London

Publications and helpful links

General Publications

• Uccelli A, Laroni A, Brundin L, Clanet M, Fernandez O, Nabavi SM, Muraro PA, Oliveri RS, Radue EW, Sellner J, Soelberg Sorensen P, Sormani MP, Wuerfel JT, Battaglia MA, Freedman MS; MESEMS study group. MEsenchymal StEm cells for Multiple Sclerosis (MESEMS): a randomized, double blind, cross-over phase I/II clinical trial with autologous mesenchymal stem cells for the therapy of multiple sclerosis. Trials. 2019 May 9;20(1):263. doi: 10.1186/s13063-019-3346-z.

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2013
• Primary Completion (Actual): August 1, 2019
• Study Completion (Actual): August 1, 2019

Study Registration Dates

• First Submitted: May 21, 2012
• First Submitted That Met QC Criteria: May 23, 2012
• First Posted (Estimate): May 25, 2012

Study Record Updates

• Last Update Posted (Actual): August 9, 2019
• Last Update Submitted That Met QC Criteria: August 7, 2019
• Last Verified: August 1, 2019

More Information

Terms related to this study

• Keywords: multiple sclerosis; bone marrow; mesenchymal stem cells; rapidly evolving
• Additional Relevant MeSH Terms: Pathologic Processes; Nervous System Diseases; Immune System Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Autoimmune Diseases; Multiple Sclerosis; Sclerosis
• Other Study ID Numbers: CRO1959; 13HH0228 (Other Identifier: Imperial College)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No